2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
SCHOLARSHIP APPLICATION – 2017
NAMIC-Carolinas mission is to create career opportunities in the Communications industry for
multi-ethnic students through a program that focuses on scholastic achievements, direct work
experience and professional development. Qualified students enrolled as a rising junior / senior
at a four-year college or entering into their second year of a two-year college in North Carolina
or South Carolina are eligible to apply. Candidates must have:
a.
b.
c.
d.
Minimum cumulative grade point average of 3.0
Must provide proof of U.S. Citizenship or have permanent residency status in the U.S.
Must possess written and verbal fluency in English.
Must include with this application, a resume or CV, most recent college/school
transcript and two references from teachers, advisors or employers.
e. Must provide an Essay (up to 500 words) including, but not limited to, the following
questions:
a. How do you see your current course of study tying into the Communications
industry?
b. How will your studies/educational focus prepare you for your career in
Communication?
c. What does Diversity and Inclusion mean to you?
d. How did you hear about this program?
_____________________________________________________________________
1. STUDENT INFORMATION (*Also please enter your name on top of each page)
Mark appropriate box below:
a. Gender:
M
F
b. Proof of Citizenship: US Citizen
Permanent Resident
c. _______________________________________________________
Last Name
First Name
MI
d. ______________________________________________________
Street Address (Permanent Residence)
Page | 1 Please return completed application to [email protected] by May 1st, 2017.
2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
e. ______________________________________________________
City
State
Zip Code
f.
________________________________________________________________________
Area Code / Home Telephone
Area Code / Other Phone #’s
g. ________________________________________________________________________
Date of Birth
Personal E-Mail Address
Ethnicity/Diverse Designation
h. ________________________________________________________________________
Name of Parent(s) or Legal Guardian(s)
Relationship
i.
________________________________________________________________________
Area Code / Daytime Telephone
j.
________________________________________________________________________
Alternate Street Address (If not living at permanent residence during school year)
k. ________________________________________________________________________
City
State
Zip Code
l.
________________________________________________________________________
Area Code / Alternate Phone #
Alternate/School Issued E-Mail Address
2. HIGH SCHOOL EDUCATIONAL RECORD (Only complete if attending a two-year
Tech School/Community College.)
a. ________________________________________________________________________
High School Name
Grade
Page | 2 Please return completed application to [email protected] by May 1st, 2017.
2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
b. ________________________________________________________________________
Current GPA
Expected Graduation Date (Month/Year)
c. ________________________________________________________________________
School Street Address
d. ________________________________________________________________________
City
State
Zip Code
County
e. Mark Appropriate Boxes:
You’re School: Public
Do You:
f.
Live at Home
Private
Live on Campus
________________________________________________________________________
Guidance Counselor’s Name
Guidance Counselor’s Telephone Number
W/Area Code and Extension
3. COLLEGE / UNIVERSITIES TO WHICH YOU ARE CURRENTLY ENROLLED
a. 1st: ____________________________ 2nd: _____________________________________
b. ________________________________________________________________________
Major(s) and/or Minor(s) – If undeclared, please state interests.
Page | 3 Please return completed application to [email protected] by May 1st, 2017.
2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
4. COLLEGE EDUCATIONAL RECORD
a. ________________________________________________________________________
College Name
b. ________________________________________________________________________
Cumulative GPA
Expected Graduation Date
c. ________________________________________________________________________
College Address
Major / Minor
d. ________________________________________________________________________
City
State
Zip Code
e. Mark Appropriate Box:
Is your school: Public
Do you: Commute
f.
Private
Live on Campus
Live in Off-Campus Housing
________________________________________________________________________
Student Advisor’s Name
Student Advisor’s Telephone #
5. HONORS
List any academic, community service or other achievements for which you have
received awards or special recognition.
Page | 4 Please return completed application to [email protected] by May 1st, 2017.
2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
6. CERTIFICATES
List any certifications, licenses, etc. that you have earned or are working to attain.
7. EXTRA CURRICULAR ACTIVITIES
List your hobbies and interests, including any extracurricular activities in which you
participate on a regular basis. Include any leadership positions you currently hold or
have held in the past.
8. FOREIGN LANGUAGES
Indicate your fluency in languages other than English. Indicate your proficiency in
comprehension, conversation, reading and writing.
9. TECHNOLOGY SKILLS
Mark the box next to the software application(s) in which you are proficient.
a. MS Word
MS Excel
MS Access
MS Power Point
Programming
Graphic Design Software (please specify): _____________________________
______________________________________________________________________
Other Software Applications (please specify): ___________________________
______________________________________________________________________
Page | 5 Please return completed application to [email protected] by May 1st, 2017.
2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
b. Detail any other technology knowledge you may have (you may attach a “brief”
sample of your work, i.e. Website development, blogs hosted, etc.)
10. AREAS OF INTEREST (check all that apply)
Industry
Function
Cable
Operations
Programmer
Marketing
News/Media
Finance
Entertainment
Engineering
Equipment Provider
Communications
11. CURRENT EMPLOYMENT (if applicable)
Provide information on any current job/s; part-time, full-time, and/or volunteer
activities.
a. ________________________________________________________________________
Employer
________________________________________________________________________
Type of Business
Date Employed
(Month / Year to Month / Year)
________________________________________________________________________
Supervisor Name & Title
Area Code / Telephone #
Page | 6 Please return completed application to [email protected] by May 1st, 2017.
2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
Briefly describe your primary/essential job responsibilities below:
b. _____________________________________________________________________
Employer
________________________________________________________________________
Type of Business
Date Employed
(Month / Year to Month / Year)
________________________________________________________________________
Supervisor Name & Title
Area Code / Telephone #
Briefly describe your primary/essential job responsibilities below:
12. SIGNATURE
My signature certifies that, to the best of my knowledge, all statements and supporting
documents related to this application are true and accurate. It further certifies that should I
be accepted into the NAMIC-Carolinas Communications Scholarship program that I will
conduct myself honorably and as a responsible member of the community. I commit myself
to be honest in academic, professional and personal endeavors.
____________________________________________________________________
Applicant’s Signature
Date
Page | 7 Please return completed application to [email protected] by May 1st, 2017.
2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
RECOMMENDATION FORM
Applicant’s Name _____________________________Phone # __________________________
Reference’s Name _____________________________Title _____________________________
School/Company Name _________________________________________________________
Address ______________________________________________________________________
Reference’s Phone # _________________E-mail _____________________________________
Instructions: This student named above is applying for the NAMIC-Carolinas Communications
Scholarship. This recommendation form has been provided for your ease and convenience. Our
program is highly competitive and exceptional qualities will make the difference during the
selection process. For that reason, we hope that you will use the “Additional Comments” section
to tell us why this student is uniquely qualified for our program. We also invite you to attach
additional pages or a formal letter of recommendation. Thank you for your time and cooperation.
Please return your recommendation, with your signature, directly to the Scholarship
Committee, not to your student. E-mail the Recommendation Form to:
[email protected].
Please check only the strengths that you personally have observed. If you have not had
the opportunity to observe the following competencies or strengths check the Not
Applicable column:
Leadership
Relationship with peers
Organization skills
Cooperation
Verbal communication skills
Written communication skills
Character (honesty, attitude)
Dress/appearance
Assertiveness
Maturity
Excellent
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Good
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Fair
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Poor
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Page | 8 Please return completed application to [email protected] by May 1st, 2017.
NA
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2017 Communications Scholarship Application
Applicant’s Name: _____________________________________ Date: __________________________
Excellent
Confidence
Class participation
Attention to detail
Attendance Punctuality
Completion of assignments
Ability to follow directions
Mathematical competency
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Good
Fair
Poor
NA
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Additional Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
___________________________________________________________________________
__________________________________________________
___________________________________
Reference’s Signature
Page | 9 Please return completed application to [email protected] by May 1st, 2017.